Suitable Image Parameters and Analytical Method for Quantitatively Measuring Cerebral Blood Flow Volume with Phase-Contrast Magnetic Resonance Imaging

The aim of this study was to determine suitable image parameters and an analytical method for phase-contrast magnetic resonance imaging (PC-MRI) as a means of measuring cerebral blood flow volume. This was done by constructing an experimental model and applying the results to a clinical application. The experimental model was constructed from the aorta of a bull and circulating isotonic saline. The image parameters of PC-MRI (repetition time, flip angle, matrix, velocity rate encoding, and the use of square pixels) were studied with percent flow volume (the ratio of actual flow volume to measured flow volume). The most suitable image parameters for accurate blood flow measurement were as follows: repetition time, 50 msec; flip angle, 20 degrees; and a 512 x 256 matrix without square pixels. Furthermore, velocity rate encoding should be set ranging from the maximum flow velocity in the vessel to five times this value. The correction in measuring blood flow was done with the intensity of the region of interest established in the background. With these parameters for PC-MRI, percent flow volume was greater than 90%. Using the image parameters for PC-MRI and the analytical method described above, we evaluated cerebral blood flow volume in 12 patients with occlusive disease of the major cervical arteries. The results were compared with conventional xenon computed tomography. The values found with both methods showed good correlation. Thus, we concluded that PC-MRI was a noninvasive method for evaluating cerebral blood flow in patients with occlusive disease of the major cervical arteries.</p

A case of successful endoscopic removal in a patient who took aconite for the purpose of suicide.

　トリカブトは山野に自生しており，山菜・薬草と間違われ誤食事故を引き起こしている．また自殺目的に用いられることもある．トリカブト中毒ではアコニチンなどのアルカロイドにより経 口摂取間もなく重症不整脈をきたし，多量摂取例では致死的となりうる．トリカブトを摂取した患 者に対し内視鏡的除去を行い良好な予後を得たので報告する．症例は20代女性，自殺目的に観賞用トリカブトの根を切って飲み，当院へ救急搬送された．来院時自覚症状を認めなかった．胃洗浄を行ったがトリカブトは確認できなかった．摂取後早期であり，トリカブトの根を切って咀嚼せず飲み込んだという病歴から，トリカブト除去目的に上部消化管内視鏡を施行したところ胃内にトリカブトの根を認め内視鏡的に除去しえた．入院後症状の出現なく，心電図変化も認めなかった．経過良好であり翌日退院となった．来院時の胃液ではヒパコニチン 5.1 ng/ml，メサコニチン 21.0 ng/ml，アコニチン 1.1 ng/ml，ベンゾイルメサコニン 3.4 ng/ml が検出されたが，血清，尿からは検出されなかった．一般的にトリカブト中毒が疑われた場合，吸収阻害を目的に胃洗浄さらに活性炭の投与を行うとされている．本症例では，病歴から固形のトリカブトが胃内に残っていると推測し，早期に内視鏡的除去を行った結果，中毒症状を呈することなく経過した．固形物を咀嚼せずに飲み込んだこと，摂取から時間が経っていないこと，物質が吸収された場合致死的であることを満たす場合には，有効な治療法となる可能性がある．　Aconite grows wild in mountains and fields, and it is often mistaken for other edible or medicinal plants, resulting in poisoning. Whilst ingestion may be accidental, it is also sometimes used for the purpose of suicide. Aconitine and other alkaloid toxins may cause severe, often fatal arrhythmias in patients with aconite poisoning, especially after high oral intake. Herein, we report the endoscopic removal of aconite from a patient after intentional ingestion. A woman in her twenties was rushed to our hospital after consuming the roots of an ornamental aconite in an attempt to commit suicide. The patient exhibited no subjective symptoms on admission. Gastric lavage was performed, but no aconite was found. An upper gastrointestinal endoscopy was performed and the aconite root, found in the stomach, was removed. The patient exhibited no symptoms or ECG changes after admission. Aconitine alkaloids, such as hypaconitine (5.1 ng/mL), mesaconitine (21.0 ng/mL), aconitine (1.1 ng/mL), and benzoyl-mesaconine (3.4 ng/mL), were detected in the gastric juice but not in the serum or urine. The patient was discharged the following day. In general, when aconite poisoning is suspected, gastric lavage and activated charcoal are administered to inhibit absorption. The ingestion of solid materials without chewing may affect absorption time. Based on the history of this case, we assumed that solid aconite remained in the stomach, thus early endoscopic removal of the aconite resulted in no symptoms of poisoning. Hence, this may be an effective and fast treatment for aconite poisoning

双生児を育てる母親の生活実態の検討

本研究では,双生児を出産してから現在に至るまでの母親の生活の実態を明らかにし,双生児を育てる母親の育児支援に対するニーズを明らかにすべく,双生児を育てる母親38組にアンケート調査を実施した。その結果は,(1)双生児の育児は日常生活で身体的な面での負担も大きい一方,ストレスにより,精神的な面に関しても負担が重なっていく,(2)育児情報が氾濫しているにも関わらず,双生児の子育てに関する情報・支援は少ない,(3)双生児の母親は夫以外に父母の援助も受けられ,睡眠に関する問題点は少ない,(4)友達づくりで得られた友達は育児に影響を与え,その役割は大きい,(5)日常生活上,多くの家庭において,双生児の育児に対する経済的な負担が大きい,であった。In order to reveal the actual conditions of mothers after giving birth to twins and find what support in rearing twins they need, we conducted a questionnaire survey on 38 mothers who are raising twins. This survey shows the following facts. 1. In addition to the considerable physical burden, raising twins imposes a stress-related mental burden on them. 2. Despite an abundance of information about child-rearing, little information and support as to raising twins is given. 3. In addition to assistance from husbands, their parents\u27 often provide assistance in rearing children. 4. They tend to experience difficulty in sleeping. 5. Their friends often have an influence on their raising children and play a large part in it. 6. Raising twins puts a great strain on family finances in many families

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era